Effective Implementation Strategies for Delivering Nutritional Interventions through the Health System to Prevent Malnutrition during Pregnancy: A Systematic Review and Meta-analysis

Malnutrition during pregnancy is a public health concern. Interventions implemented through the health sector can prevent maternal malnutrition. Our aim was to identify implementation strategies for delivering nutritional interventions through primary health care to prevent malnutrition in all its forms during pregnancy. We included 51 studies conducted across high-middle, and low-income countries. Multiple micronutrient supplementation (MMS) was more effective than iron and folic acid (IFA) supplementation alone in improving hemoglobin concentrations and other anemia-related indicators, when initiated during the first or second trimester of pregnancy and delivered with in-person, individualized counseling and follow-up. Our meta-analysis confirmed that MMS improved maternal anemia compared with IFA with a moderate certainty of the evidence. Healthy eating, counseling, physical activity, and weight-gain monitoring, when combined, were effective in achieving weight gain when the interventions were guided by prenatal care protocols and included materials and resources to support.

A coordinated package of health system delivered interventions, including MMS, behavioral counseling, and monitoring of maternal weight gain, should be implemented within primary health care, beginning in the first or second trimester, to prevent all forms of malnutrition during pregnancy. Effective implementation strategies to provide these interventions can be adapted to local contexts.